Currently 300,000 Americans suffer from end-stage renal disease (ESRD), which is associated with substantial morbidity and mortality. Recent data suggest there is a much larger number of individuals who have impaired kidney function not requiring dialysis or transplantation (i.e., chronic renal insufficiency). However, the health consequences and public health burden of chronic renal insufficiency (CRI) are incompletely defined. We hypothesize that the relationship between CRI prevalence and subsequent ESRD incidence varies across demographic and disease subgroups because of differences in rates of decline of renal function and competing mortality risks. We hypothesize that the metabolic and homeostatic disturbances of CRI lead to osteopenia, periodontal disease and blood pressure elevation. Expression of these consequences of CRI may be influenced by dietary factors such as intake of sodium, calcium and other dietary components. We hypothesize that CRI is associated with reduced physical functioning. We will analyze the nationally representative Second (1976-80) and Third (1988-94) National Health and Nutrition Examination Survey (NHANES II and III) databases which contain information on renal function as well as detailed assessment of health and nutrition status. We will use the nationwide and comprehensive US Renal Data System ESRD registry (1988-present) to examine the relationship between CRI prevalence and subsequent ESRD incidence in specific birth cohorts. We will collect longitudinal data on physical functioning, body composition and nutritional status in a separate cohort of CRI subjects. Linear, logistic and Poisson regression and longitudinal data analysis techniques will be used to assess the independent association of CRI with outcomes. The overall objective of this application is to support my development in a career focused on patient-oriented research in nephrology. To accomplish this objective, the proposed program has both scientific and career development components. The scientific component is outlined above. The first career development objective is to strengthen my analytic skills and increase my sophistication as a clinical researcher through formal course work, directed reading and one-on-one tutorials. The second career development objective is to obtain training in creating and following a cohort of subjects with CRI and conducting primary data collection. These will contribute greatly to my development into an independent investigator.